Frequent medical absences in secondary school students: survey and case-control study.

OBJECTIVE: To determine the prevalence of frequent absence (>20% of the school year) for reasons recorded as "medical" in secondary schools; to test the hypothesis that it is associated with physical symptoms and psychiatric disorder and not with serious organic disease; to assess unmet need for psychiatric management. DESIGN: Survey using routinely collected data and case-control study SETTING: Local authority secondary schools in Edinburgh, UK. PARTICIPANTS: School students in the first 4 years of secondary school: cases were those with frequent medical absence and controls those with a good attendance record (best 10% of year group), matched for age, gender and school class. MEASURES: Period prevalence of frequent absences. Cases and controls (students and their parents) completed questionnaires about the students' symptoms. Students were given a psychiatric diagnostic interview and a medical examination. The records of specialist medical services used by the students were reviewed. RESULTS: A substantial minority (2.2%) of students had frequent medical absences. Only seven of 92 (8%) cases had a serious organic disease and 10 of 92 (11%) had symptom-defined syndromes; the remainder had physical symptoms and minor medical illness. Frequent medical absence was strongly associated with psychiatric disorder (45% in cases vs 17% in controls, p<0.001, 95% CI for odds ratio 1.37 to 4.02). Only 14 of the 41 cases (34%) with a psychiatric diagnosis had attended NHS psychiatric services. CONCLUSIONS: Frequent absence for medical reasons is common, and more comprehensive management, including psychiatric assessment, is required to prevent long-term adverse consequences.

The role of workload and driver coping styles in predicting bus drivers' need for recovery, positive and negative affect, and physical symptoms.

A survey was conducted on a sample of 159 Australian bus drivers to determine the extent to which workload and self-reported driver coping styles predicted their subjective health status. The model that was proposed incorporated the hours spent driving as a measure of workload, both adaptive and maladaptive driver coping styles, and self-report measures of need for recovery (i.e., fatigue), positive and negative affect (PA and NA), and physical symptoms. The results of hierarchical regression analyses revealed that the workload was a significant predictor of drivers' need for recovery, but not of their PA and NA nor of their physical symptoms. Need for recovery was in turn a significant predictor of PA and NA and of their physical symptoms, indicating that it mediates the influence of workload on PA and NA and physical symptoms. Two maladaptive coping strategies added to the prediction of need for recovery, as well as to the prediction of NA, even after controlling for the influence of need for recovery. One adaptive coping strategy added to the prediction of PA. Strategies for management of fatigue in bus drivers should focus on the assessment and remediation of maladaptive coping strategies which impact of drivers' need for recovery, which in turn predicts PA and NA and physical symptoms.

Symptom control in children and adolescents with attention-deficit/hyperactivity disorder on switching from immediate-release MPH to OROS MPH Results of a 3-week open-label study.

AIM: The aim of this study was to assess the impact of switching from immediate-release (IR) methylphenidate (MPH) to OROS MPH (CONCERTA, a once-daily long-acting MPH formulation, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: Subjects with ADHD aged 6-16 (n=105),who were stably maintained on their current IR MPH regimen (10-60 mg/day), were switched to 18, 36 or 54 mg OROS MPH once daily for 21 days, depending on pre-study daily MPH dose. ADHD symptoms were assessed by parents, teachers and investigators. RESULTS: By Day 21, parent/caregiver IOWA Conners ratings had decreased from baseline by 2.7 points to 5.2 (I/O), and by 1.8 points to 5.0 (O/D). Teacher IOWA Conners ratings were maintained. Decreases in IOWA Conners ratings are indicative of ADHD symptom improvement. Approximately 75% of parents and investigators rated therapy as good or excellent. OROS MPH therapy was well tolerated. CONCLUSIONS: Switching from IR MPH to OROS MPH maintained and may have improved symptom control in children and adolescents with ADHD, during the course of this study. The changes in parent/caregiver IOWA Conners ratings suggest that OROS MPH improves symptom control in the after-school period. This is consistent with the 12-h duration of action previously demonstrated for OROS MPH.

Parental perception of the quality of life among children with epilepsy or diabetes with a new assessment questionnaire.

This paper describes the evaluation of a newly designed questionnaire to assess the quality of life among children with epilepsy or diabetes. Factor analysis identified one factor, the impact on the parents and the family, which was responsible for over a third of the variance in the two illness groups. Two other factors, impact on development and impact on health, were also found in the epilepsy group. The questionnaire discriminates well between children with epilepsy or diabetes, showing that the former is more affected than the latter. Children with more severe epilepsy are seen by parents to have a worse quality of life than children whose epilepsy is well controlled.

Eating habits, body-esteem and self-esteem in Scottish children and adolescents.

Two hundred ninety-nine girls, from primary school grade 6 to senior school grade 4 classes in a Scottish, independent, single-gender school completed three questionnaires assessing body-esteem, self-esteem, and eating behavior. The aim of the study was threefold: to see whether there was a significant increase in more abnormal eating habits during adolescence; to see whether there was a significant decline in body-esteem during adolescence; and to see whether there was any association between eating habits, body-esteem, and self-esteem. The results provided some evidence in support of the first two hypotheses and also indicated a strong association between a low level of self-esteem and dislike of body shape, and an abnormal pattern of eating. The risks and implications of dieting in this age group are also discussed.

A community survey of children with severe intellectual disability and their families: psychological adjustment, carer distress and the effect of respite care.

The present paper describes a cross-sectional study of the psychosocial adjustment of 143 children with severe disability and their families identified from a regional case register for children with special needs. Thirty-eight per cent of the children had significant psychiatric morbidity. By contrast, the overall level of distress in carers was not that different from probable community prevalence figures. Nevertheless, distress among carers was consistently associated with increased disability in the child. Although respite care is a valuable resource for many carers, its use is indicative of underlying distress in the carer.

The quality of life of children with chronic epilepsy and their families: preliminary findings with a new assessment measure.

The aim of this study was to develop and validate a new schedule to measure the impact of epilepsy on children and their families. 30 questions assess four aspects of the child's and family's lifestyle: epilepsy and its treatment, impact on the child, impact on the parent and impact on the family. For each question, two dimensions are considered: the frequency of the problem, and its importance or degree of concern that it causes. The questionnaire was piloted on the parents of 21 children with chronic epilepsy attending a seizure clinic. Epilepsy was well controlled in half of the children and poorly controlled in the remainder. The questionnaire discriminated well between the two groups of children. Further research will be undertaken to assess the usefulness of the questionnaire on a larger and more representative group of children with epilepsy.

Self-esteem and behavioural adjustment in children with epilepsy and children with diabetes.

This paper describes a study to investigate the relationship between self-esteem and behavioural adjustment in two groups of children with chronic illness, one with epilepsy and the other diabetes. A total of 62 children with epilepsy and 91 children with diabetes were recruited from the total population of children aged 8-15 attending the epilepsy and diabetic clinics at a children's hospital over a 12 month period. Self-esteem and behavioural adjustment were assessed with the Harter and Achenbach Questionnaires respectively. The results showed the children with epilepsy were consistently more behaviourally disturbed and had lower self-esteem than children with diabetes. The independent completion of the questionnaires, (the Harter by the child and the Achenbach by the parents) increases the validity of the findings. Long duration of illness was the most consistent illness variable associated with poor behavioural adjustment in the two groups. The cross-sectional design of the study did not make it possible to draw any definite conclusions about the causal or temporal relationship between low self-esteem and behavioural disturbance. Once again, the potential value of prospective studies into the psychosocial adjustment of children with chronic illness is highlighted.

The quality of life of children with chronic epilepsy and their families.

This paper describes the study investigating the quality of life among 108 school children with chronic epilepsy attending the epilepsy clinic at a children's hospital. Quality of life measurement was assessed with two questionnaires completed by the parents. The results showed clearly that epilepsy has the greatest impact among children who not only had intractable epilepsy but also had additional disabilities. The adverse impact was evident in three main areas: the management of epilepsy including the side effects from anticonvulsants; the deleterious effects on the child's adjustment and development and the restrictions on family life and activities. It would seem sensible to concentrate scarce professional resources on this group of children and their families.

The modification and standardisation of the Harter self-esteem questionnaire with Scottish school children.

This paper describes a study to modify an American questionnaire measuring self-esteem in children for use in the United Kingdom and also to obtain normative values for this questionnaire with Scottish school children aged 8-15 years. Five thousand children resident in the Lothian Region of Scotland, a 5% sample of the age group, were identified using a cluster sampling technique in order to provide a random sample of the general population for this age group. The main findings were as follows: children usually rated themselves higher than the midpoint on most subscales, indicating that they have a positive regard for themselves; boys tended to rate themselves higher than girls on most subscales except behaviour; scores tended to decline as children get older, especially for girls; global or overall self-esteem was highly correlated with the other subscales, especially physical appearance or attractiveness; self-esteem scores were not influenced by social class, school or religion. The modified Harter questionnaire can be used to measure self-esteem in several situations. These include comparisons between different groups of children, changes in self-esteem following treatment interventions or the effects of illness on children's psychological adjustment. Finally, the study has provided normative values for a Scottish population of school children aged 8-15 years.

Helping parents and children with epilepsy cope successfully: the outcome of a group programme for parents.

This paper describes a study to determine the effectiveness of a group programme for parents designed to reduce the psychosocial morbidity among children with epilepsy and their families. The participants were the parents of 108 children attending the seizure clinic at a children's hospital. The first part of the project had shown that half of the children and their families had considerable morbidity. Despite the high rate of psychosocial morbidity among these children and their families, only 35% of the parents expressed an interest in participation in the intervention programme, with only 12% attending any meetings. The latter were mainly the small number of parents whose children had severe intractable epilepsy as well as educational and family problems. Many parents did, however, request more information about epilepsy and for the provision of a counselling service. The latter is likely to be most beneficial in the months following diagnosis.

Psychosocial adjustment of children with chronic epilepsy and their families.

A cross-sectional study was undertaken of psychosocial morbidity among 108 children with chronic epilepsy and their families. Approximately half the children showed evidence of significant psychological disturbance. Neurotic or emotional disturbance was the most common diagnostic category, with similar rates of disturbance among boys and girls; findings not reported previously. Behavioural disturbance was strongly associated with epileptic variables, family factors, individual characteristics of the child and with maternal anxiety about epilepsy. Several factors are responsible for this increase, and further study is needed to elucidate these and to reduce the incidence of psychosocial morbidity among these children.

The effect of maternal psychotic illness on a child.

We report the case of an 11-year-old girl who had been living with only her mother, a woman with chronic schizophrenia. The girl had been caught shoplifting with her mother, and had a long history of non-attendance at school. The case emphasises that adult psychiatrists should always consider the impact of chronic parental psychiatric disorder on children, particularly in one-parent families.

Adults' attitudes to children with epilepsy: the use of a visual analogue scale questionnaire.

A new visual analogue questionnaire was used to compare attitudes to epilepsy in childhood among the parents of three groups of children, one with epilepsy, one with diabetes and one with healthy children. The results showed that there were more similarities than differences between the groups. The parents of the children with epilepsy were knowledgeable about the educational and behavioural problems of children with epilepsy, although they often regarded epilepsy as a sign of serious disease. There was also an association between the severity of their child's epilepsy and high questionnaire scores among the parents of children with epilepsy. This questionnaire could be used by paediatricians to assess whether parents' views are realistic for their child and also to evaluate the effectiveness of an intervention study to modify inappropriate attitudes among parents of children with epilepsy.

Psychiatric disturbance in the families of epileptic children.

The rates of psychiatric disturbance among the parents and school-age siblings of two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with those of adults and children in the general population. Siblings of children in the newly diagnosed group were no more disturbed than children in the general population, whereas those of children with chronic epilepsy were. The parents of both groups were no more disturbed than adults in the general population, but there was an association between disturbance in the chronically epileptic children and increased psychiatric morbidity among their mothers. Professionals involved in the care of epileptic children should be aware of the effects on the psychological health of other members of the family, and of ways of helping the child and the family to cope with the illness.

Does illness foster dependency? A study of epileptic and diabetic children.

The development of inappropriate dependency was investigated among two comparable groups of children, one with newly diagnosed epilepsy or diabetes, the other with chronic epilepsy or diabetes. The two groups of epileptic children were significantly more dependent than the two diabetic groups, and than children in the general population. Psychiatric disturbance was significantly more common among the epileptic children, and possibly is a factor in their inappropriate dependency. Specific advice and counselling for the parents is likely to help promote the children's sense of self-esteem and independence.

The development of psychiatric disorder among schoolchildren with epilepsy.

Two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with two comparable groups of diabetic children and with children in the general population in order to investigate the development of psychiatric disorder. The results confirm previous findings that children with chronic epilepsy are significantly more disturbed than children with chronic physical illness not involving the central nervous system, and than children in the general population. Children with newly diagnosed epilepsy were also significantly more disturbed than those with newly diagnosed diabetes, and than children in the general population. The rate of psychiatric disturbance was similar in the two groups of epileptic children. In both groups of epileptic children, those with focal EEG abnormalities and/or complex partial seizures were particularly vulnerable to psychiatric disturbance.